Trematodes

Characteristics

Flattened Dorsally
Non-segmented
Inhabit the gastro-intestinal tract or tissues of man
Their length ranges from few mm. to several mm.
There are 2 oral and 2 ventral cup-shaped muscular suckers (acetebula)

1. They live in the man as definitive host.

a. In the intestines
Fasciolopsis buski
Heterophyes heterophyes
b. In liver or bile ducts
Fasciola hepatica
Chlonorchis sinensis
c. In the lungs
Paragonimus westermani
2. Specific species of snails are required as Intermediate host for each fluke.

LIFE CYCLE

1. The Adult worm lays eggs that leave definitive host(man) through feces or
sputum.
2. Eggs develop in water into ciliated larva known as Miracidium
3. Miracidium penetrates the snail (1st IH)
4. Sporocyst develops into Redia
5. Redia develops into Cercaria
6. Cercaria leaves snail and encyst as Metacercaria(Infective stage)
7. Metacercaria are found:
a. On water, plants
Fasciolopsis buski
Fasciola hepatica
b. In fish as 2nd intermediate host
Heterophyes heterophyes
Chlonorchis sinensis
c. In crab or cray fish
Paragonimus westermani
8. Metacercaria are consumed by Man.

Intestinal Flukes

Fasciolopsis buski
 Heterophyes heterophyes

Fasciolopsis buski

- Definitive Host: Humans, hogs and occasionally dogs

- Adult fluke: Considered as Largest Parasitic trematode of humans
- Primary intermediate hosts: Planorbid snails of genera segmentina, Hippeutis
and Gyraulus.
- Disease: Fasciolopsiasis
- Fasciolopsis causes mucosal sucker
- Diagnosis: Finding the ova in feces bile-stained oval, operculated with lid.
- Intermediate Host for F.buski
a. Snail in the Genus Hippeutis
b. Snail in the Genus Segmentina

Heterophyes heterophyes

- 1st IH: Blackish water snails known as Pirenella

- 2nd IH: Fish Chiefly Mugil (Mullet)
- Definitive Host: Man
- Disease: Heterophyiasis
- Heterophyes usually asymptomatic

Diagnosis

a. Made by finding the egg seen in the rusty flecks of sputum

b. Eggs may also appear in feces when sputum is swallowed?
c. The egg are underdeveloped, operculated and with terminal shell thickening.

Liver Flukes

Chlonorchis sinensis
Fasciola hepatica

Chlonorchis sinensis

- Known as the Chinese or oriental liver fluke

- 1st IH: Snails known as Parafossarulus
- 2nd IH: Fish
- Definitive host: Man
- Disease: Chlonorchiasis
- Chlonorchis: jaundice, hepatomegaly, abdominal pain

Diagnosis

- Finding the ova of the parasite described as Old-fashioned electric bulb

- Fecal examination must be repeated if found negative.
Fasciola hepatica

- Parasite of sheep, cattle, deer and rabbits as well as other herbivorous

mammals.
- 1st IH: snail known as Lymnaea truncutula
- 2nd IH: watercress kangkong
- Definitive host: Man
- Diseases: Fascioliasis Liver rot sheep liver fluke
- Fasciola causes fever, hepatomegaly
- Diagnosis: Finding the ova (same appearance with F.buski)

Lung Fluke

Paragonimus westermani

Paragonimus westermani

- 1st IH: Snails known as Hua, Semisuluspira

- 2nd IH: Fresh water Crabs known as Parathelpusa
- Definitive host: Variety of Carnivores such as Cats, Dogs, Rats.
- Disease: Paragonimiasis, Pulmonary distomiasis
- Paragonimus: causes rusty sputum (composed of flecks blood+charcot-
leyden crystals + eggs) cough and chest pain.

Diagnosis:

- Established by finding the eggs in sputum, feces or less frequently in

aspireated material from abscesses or pleural effusion.

Blood Fluke

Schistosoma japonicum
Schistosoma mansoni
Schistosoma haematobium

1. Adult male and female coexist in pairs during the life span.
2. Their cylindrical shapes are suitable for life in vessels, the adults maybe
found:
a. In veins around small and large intestine:
- Schistosoma mansoni: Lives in veins adjacent to large intestines
- Schistosoma japonicum: Lives in the veins adjacent to small intestines.
- Schistosoma haematobium: Lives in veins around the urinary bladder.
3. Adult fluke lays eggs (containing developed miracidium which leave
definitive host in feces or urine)
a. Miracidium hatches in water and enters snail (first intermediate)
b. Mother, then daughter sporocyst develop into cercaria in snail.
c. Free- swimming cercaria (infective stage) leaves snail and penetrate
skin of man.
 d. Schistosomule (cercaria minus tail) travels through blood vessels to
develop in appropriate veins.
a. Schistosoma mansoni- lateral spine
b. Schistosoma haematobium terminal spine
c. Schistosoma japonicum- lateral knob

A. Infection is known as Schistosomiasis or Bilharziasis. Ranks 2 nd to malaria as

cause of worldwide morbidity and mortality
a. Rectal or intestinal Schistosomiasis caused by Schistosoma mansoni
b. Oriental Schistosomiasis (katayama disease) caused by Schistosoma
japonicum
c. Vesicular schistosomiatsis, urinary biharziasis, schistosoma hematuria
caused by Schistosoma haematobium.
B. The host reacts to spined eggs causing granuloma formation
C. Worms in the intestinal veins form:
- Hepatic region
- Splenomegaly
- Cerebral reactions caused by S.japonicum
D. Worms in veins around urinary bladder (S.haematobium)
- Sloughing tissues, calcium deposits, eggs,bloodclots and mucus may obstruct
ureters or urethra.
- Mechanical and toxic irritation of eggs predisposes to bladder carcinoma.
E. They cause cercarial dermatitis (swimmers itch)
- Fork-tailed cercariae produce allergic reaction in man at fresh water
swimming pots.
- Man is the unnatural definitive host. The cercariae penetrate only outer
dermal layer are destroyed there.
a. S. mansoni and S.japonicum: eggs can be found in rectal biopsy or in
feces.
b. S.mansoni has eggs with well developed lateral spine no operculum
c. S.japonicum has eggs with minute, indistinct lateral spine.
d. S.haematobium eggs are found in urine. Eggs have terminal spine and
accompanied by hematuria or bloodclots in the last few drops of voided
urine.

Note: Schistosoma is the only trematode with the only one intermediate host
which is the snail (Oncomelania quadrasi) and with non operculated ova.